Personal Insurance

                              Personal Insurance

• List of Garages for Cashless Settlement 

• New India Top Up Mediclaim 

• New India Floater Mediclaim Policy

• New India Asha Kiran Policy

• Mediclaim 2012 Policy

• Pravasi Bharatiya Bima Yojana Policy (418 KB) 

• Mediclaim 2007 Policy (NO FRESH ISSUANCE ONLY RENEWAL)

• Family Floater Mediclaim Policy (NO FRESH ISSUANCE ONLY RENEWAL)

• Janata Mediclaim Policy

• Senior Citizen Mediclaim Policy

• Personal Accident Policy

• Overseas Mediclaim Policy

• Householder's Policy

• Motor Policy

• Money Insurance

• Rasta Apatti Kavach (Road Safety Insurance)

• Suhana Safar Policy

• TV/VCR/VCP Insurance

• Mobile/Cellular Phone Insurance

• Other Personal Insurance

• Group Mediclaim Policy

• GRIHA SUVIDHA Policy    

New India Top Up Mediclaim

• SALIENT FEATURES OF THE POLICY

• WHO CAN TAKE THE POLICY

• ELIGIBILITY

• PROCEDURE FOR TAKING A POLICY

• TENURE OF THE POLICY

• SUM INSURED

• THRESHOLDS

• ENHANCEMENT OF SUM INSURED AND THRESHOLD

• PAYMENT OF PREMIUM

• PREMIUM COMPUTATION

• DETAILS OF COVERAGE

• EXCLUSIONS

• CLAIM PROCEDURE

• CLAIMS ADJUDICATION

• CANCELLATION

• TAX REBATE

• RENEWAL

• PREMIUM TABLE

TopTop SALIENT FEATURES OF THE POLICY

• This Policy covers In–Patient Hospitalisation Expenses incurred in India.

• This policy will respond only when the aggregate of all Hospitalisation expenses (except Pre / Post hospitalization expenses) of one or all members of the policy, exceeds the “Threshold” stated in the policy.

• This Policy will respond for each and every Hospitalisation after the Threshold has been exceeded by previous Hospitalisation expenses subject only to the Sum Insured stated in the Policy.

• The Sum Insured is the maximum liability of the company for all members of the policy.

• Thus, this Policy offers protection in excess of any Primary Health Policy/Benefit scheme that the Insured may have.

• If there is any expense in excess of Threshold, receivable from any other entity, the Insured Person has an option to recover it from either that entity or this policy, but not both.

• However, the Sum Insured under the policy will be available over and above any reimbursement received from any other entity if such amounts exceed the Threshold.

TopTop WHO CAN TAKE THE POLICY

• Any person fulfilling the eligibility norms given below.

• The person may or may not have any other Health Insurance Policy.

• This policy can be taken in addition to any other Health Insurance Policy.

TopTop ELIGIBILITYTopTop PROCEDURE FOR TAKING A POLICY

• The following are to be submitted–

• Proposal form duly completed & signed and details of Insured Person/s.

• The details of existing and previous Health Insurance policies in respect of each Insured Person are to be provided without fail in the proposal form along with claim history. Copy of current/expiring policy may be attached.

• Signed copy of Prospectus.

1. For persons above 50 years of age OR

1. For persons with Adverse Medical/claims history.

1. Has / Have undergone more than two hospitalisation in previous two years,

1. Is Suffering from incurable/chronic diseases needing recurring treatment of any kind, such as Renal Failure, Cancer, Parkinson’s disease, and Diabetes Mellitus type II

1. Is Suffering from Hypertension / Diabetes.

1. is not in good health and free from Physical and mental diseases or infirmity or medical complaints

• CBC	ROUTINE URINE
  BLOOD SUGAR (FASTING & PP)	ECG
  SGPT	X–RAY CHEST PA VIEW
  SGOT	PHYSICIAN CHECK–UP
  CHOLESTEROL	HDL CHOLESTEROL
  TRIGLYCERIDES	EYE CHECK–UP FOR CATARACT & GLUCOMA

TopTop TENURE OF THE POLICYTopTop SUM INSURED

• Coverage Type	Sum Insured	Threshold
  A	5,00,000	5,00,000
  B	10,00,000	5,00,000
  C	15,00,000	5,00,000
  D	7,00,000	8,00,000
  E	12,00,000	8,00,000
  F	17,00,000	8,00,000
  G	22,00,000	8,00,000

TopTop THRESHOLDS

• The admission in the Hospital should have happened during the policy period.

• The Insured should have been admitted as an inpatient (outpatient treatments are not to be considered).

• The Hospitalisation should be for an Injury or Illness.

• Pre–Hospitalisation and Post–Hospitalisation expenses will not be considered.

TopTop ENHANCEMENT OF SUM INSURED AND THRESHOLD

• Enhancement of Sum Insured and Threshold will not be considered during the currency of the Policy.

• Enhancement of Sum Insured and Threshold is available only at the time of renewal.

• Sum Insured can be enhanced only to next band.

• Enhancement of Sum Insured will not be considered for persons

• Over 65 years

• Suffering from Diabetes, Hypertension, any chronic Illness, any recurring Illness, Any Critical Illness.

• who have preferred any claim under this policy in the previous two policy periods.

TopTop PAYMENT OF PREMIUMTopTop PREMIUM COMPUTATION

• New India Top Up Mediclaim Policy–	Eldest member of family is to be considered as Primary Member.
  	All other members of family will be considered as additional members.

TopTop DETAILS OF COVERAGE

1. Room Rent, boarding and nursing expenses actually incurred subject to a cap of Rs. 5000 per day for Rs. 5,00,000 Threshold and Rs. 8000 per day for Rs. 8,00,000 Threshold.

1. Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses actually incurred subject to a cap of Rs. 10,000 per day for Rs. 5,00,000 Threshold and Rs. 16,000 per day for Rs. 8,00,000 Threshold .

1. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees.

1. Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, Cost of Prosthetic devices implanted during surgical procedure like pacemaker, Relevant laboratory / Diagnostic test, X-Ray and other medical expenses related to the treatment.

1. Hospitalization expenses (excluding cost of organ) incurred on the donor during the course of organ transplant to the insured person. The Company’s liability towards expenses incurred on the donor and the insured recipient shall not exceed the Sum Insured of the insured person receiving the organ.

1. Get Well Benefit of Rs. 5000 for Rs. 5,00,000 Threshold and Rs. 8000 for Rs. 8,00,000 Threshold, will be paid for Any One Illness. This benefit will be payable only for the first four admissible claims under the Policy. This benefit will reduce the Sum Insured.

1. Ambulance service expenses actually incurred subject to cap of Rs. 5000 for Rs. 5,00,000 Threshold and Rs. 8000 for Rs. 8,00,000 Threshold. Payment under this benefit will reduce the Sum Insured. Ambulance charges will be paid once for Any One Illness for each Insured.

1. Hospital cash will be paid at the rate of Rs. 500 per day for Rs. 5,00,000 Threshold and Rs. 800 per day for Rs. 8,00,000 Threshold; maximum for 10 days for Any One Illness.This benefit will reduce the Sum Insured. Hospital cash will be paid for completion of every 24 hours as a day but not part thereof.

1. Payment of any claim relating to Cataract for each eye shall not exceed Rs.50,000/–.

1. AYUSH Treatments are payable provided the treatment has been undergone in a government hospital or in any institute recognized by government and/or accredited by Quality Council of India/National Accreditation Board on Health.

TopTop EXCLUSIONS

• Treatment of any Pre–existing Condition / Disease, until 48 months of Continuous Coverage of such Insured Person have elapsed, from the Date of inception of his/her first Top Up Policy as mentioned in the Schedule.

• Any Illness contracted by the Insured person during the first 30 days of the commencement date of this Policy. This exclusion shall not however, apply if the Insured person has Continuous Coverage for more than twelve months.

• Unless the Insured Person has Continuous Coverage in excess of twenty four months of Top Up Policy, expenses on treatment of the following Illnesses are not payable:

S.No.	Name of Disease/Ailment/Surgery not covered for
1	All internal and external benign tumours, cysts, polyps of any kind, including benign breast lumps
2	Benign ear, nose, throat disorders
3	Benign prostate hypertrophy
4	Cataract and age related eye ailments
5	Congenital Internal Disease.
6	Diabetes Mellitus
7	Gastric/ Duodenal Ulcer
8	Gout and Rheumatism
9	Hernia of all types
10	Hydrocele
11	Hypertension
12	Non Infective Arthritis
13	Piles, Fissures and Fistula in anus
14	Pilonidal sinus, Sinusitis and related disorders
15	Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident
16	Skin Disorders
17	Stone in Gall Bladder and Bile duct, excluding malignancy
18	Stones in Urinary system
19	Treatment for Menorrhagia/Fibromyoma, Myoma and Prolapsed uterus
20	Varicose Veins and Varicose Ulcers

• Unless the Insured Person has Continuous Coverage in excess of forty eight months of Top Up Policy, expenses on treatment of the following Illnesses are not payable:

S.No.	Name of Disease/Ailment/Surgery not covered for
1	Joint Replacement due to Degenerative Condition
2	Age–related Osteoarthritis & Osteoporosis

• Pre and Post Hospitalisation medical expenses.

• Expenses incurred for Naturopathy Treatment, acupressure, acupuncture, magnetic and such other therapies.

• War invasion, Act of foreign enemy, War like operations, Nuclear weapons, ionizing radiation, contamination by radio activity, by any nuclear fuel or nuclear waste or from the combustion of nuclear fuel.

• Circumcision, cosmetic or aesthetic treatment, plastic surgery unless required to treat Injury or Illness.

• Vaccination or inoculation.

• Cost of braces, equipment or external prosthetic devices, non–durable implants, eyeglasses, Cost of spectacles and contact lenses, hearing aids including cochlear implants, durable medical equipment.

• Dental treatment or surgery of any kind except arising out of an Accident.

• Convalescence, general debility, 'Run–down' condition or rest cure, obesity treatment and its complications, treatment relating to all psychiatric and psychosomatic disorders, infertility, sterility, Congenital External Disease, Venereal disease, intentional self–injury and Illness or Injury caused by the use of intoxicating drugs / alcohol.

• Bodily injury or sickness due to wilful or deliberate exposure to danger (except in an attempt to save human life), intentional self–inflicted injury, attempted suicide, arising out of non–adherence to medical advice.

• Treatment of any Bodily injury sustained whilst or as a result of active participation in any hazardous sports of any kind.

• Treatment of any bodily injury sustained whilst or as a result of participating in any criminal act.

• Sexually transmitted diseases, any condition directly or indirectly caused due to or associated with Human T–Cell Lymphotropic Virus Type III (HTLB–III) or lymphotropathy Associated Virus (LAV) or the Mutants Derivative or Variation Deficiency syndrome or any syndrome or condition of a similar kind commonly referred to as AIDS.

• Diagnosis, X–Ray or Laboratory examination not consistent with or incidental to the diagnosis of positive existence and treatment of any ailment, sickness or injury, for which confinement is required at a Hospital/Nursing Home.

• Vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending physician.

• Maternity Expenses, treatment arising from or traceable to pregnancy, miscarriage, abortion or complications except abdominal operation for extra uterine pregnancy (Ectopic Pregnancy), which is proved by submission of Ultra Sonographic Report and Certification by Gynaecologist that it is life threatening one if left untreated.

• Genetic disorders and stem cell implantation / Surgery.

• External and or durable Medical / Non–medical equipment of any kind used for diagnosis and or treatment.

• Domiciliary Hospitalization.

• Unproven / Experimental Treatment.

• Change of treatment from one system to another unless recommended by the consultant / hospital under which the treatment is taken.

• Any kind of Service charges, Surcharges, Admission Fees/Registration Charges levied by the hospital.

• All non–Medical expenses of any kind whatsoever.

• Treatment for Age Related Macular Degeneration (ARMD), drugs such as Avastin or Lucentis or Macugen and other related drugs, treatments such as Rotational Field Quantum Magnetic Resonance (RFQMR), External Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP), Hyperbaric Oxygen Therapy.

• Treatment taken outside India.

TopTop CLAIM PROCEDURETopTop CLAIMS ADJUDICATION

• Claim lodged by the Insured				Insured having an Individual policy of 8 Lakhs			Insured having a Top Up of 12 Lakhs with Threshold 8 Lakhs
  Paticulars	Charges	Days	Amount	Sum Insured	8,00,000	Threshold	8,00,000
  Room Rent	10,000	20	2,00,000	Room Rent (1% of Sum Insured)	1,60,000	Room Rent (Maximum Rs. 8000 for opted Threshold of Rs. 8 lakhs)	1,60,000
  Surgeon Charges	-	-	4,00,000	Surgeon Charges (proportionate on SI)	3,20,000	Surgeon Charges (proportionate on SI)	3,20,000
  Diagnostics	-	-	3,20,000	Diagnostics (proportionate on SI)	2,56,000	Diagnostics (proportionate on SI)	2,56,000
  Medicines	-	-	2,50,000	Medicines (Actual)	2,50,000	Medicines (Actual)	2,50,000
  Total Cost	-	-	11,70,000	-
  -				Admissible	9,86,000	Admissible	9,86,000
  -				Payable under policy	8,00,000	Deductible under Top Up	8,00,000
  -				Not Admissible	1,86,000	Payable under Top Up	1,86,000
  Insured Incurred				Rs. 11,70,000
  Total Paid under the Policy				Rs. 8,00,000		Rs. 1,86,000
  Expense borne by Insured				Rs. 1,84,000

• Claim lodged by the Insured				Insured having an Individual policy of 5 Lakhs			Insured having a Top Up of 10 Lakhs with Threshold 5 Lakhs
  Paticulars	Charges	Days	Amount	Sum Insured	5,00,000	Threshold	5,00,000
  Room Rent	5,000	20	1,00,000	Room Rent (1% of Sum Insured)	1,00,000	Room Rent (Maximum Rs. 5000 for opted Threshold of Rs. 5 lakhs)	1,00,000
  Surgeon Charges	-	-	4,00,000	Surgeon Charges (Actual)	4,00,000	Surgeon Charges (Actual)	4,00,000
  Diagnostics	-	-	3,20,000	Diagnostics (Actual)	3,20,000	Diagnostics (Actual)	3,20,000
  Medicines	-	-	2,50,000	Medicines (Actual)	2,50,000	Medicines (Actual)	2,50,000
  Total Cost	-	-	10,70,000	-
  -				Admissible	10,70,000	Admissible	10,70,000
  -				Payable under policy	5,00,000	Deductible under Top Up	5,00,000
  -				Not Admissible	5,70,000	Payable under Top Up	5,70,000
  Insured Incurred				Rs. 10,70,000
  Total Paid under the Policy				Rs. 5,00,000		Rs. 5,70,000
  Expense borne by Insured				Rs. 0

TopTop CANCELLATION

• SHORT PERIOD REFUND RATE TABLE

  PERIOD ON RISK	RATE OF PREMIUM TO BE CHARGED (RETAINED)
  Up to one month	1/4th of the annual rate
  Up to three months	1/2 of the annual rate
  Up to six months	3/4th of the annual rate
  Exceeding six months	Full annual rate

TopTop TAX REBATETopTop RENEWALTopTop PREMIUM TABLE

• Threshold (Rs)	Sum Insured (Rs)	Premiums applicable at different ages (excluding tax)
  		PRIMARY MEMBER
  		18-44	45-54	55-60	61-65
  5,00,000	5,00,000	1,800	2,900	4,020	6,700
  	10,00,000	2,800	4,500	6,300	10,500
  	15,00,000	3,500	5,600	8,040	13,400
  8,00,000	7,00,000	1,600	2,500	3,840	6,400
  	12,00,000	2,300	3,700	5,760	9,600
  	17,00,000	3,000	4,700	7,440	12,400
  	22,00,000	3,600	5,600	8,940	14,900

• Threshold (Rs)	Sum Insured (Rs)	Premiums applicable at different ages (excluding tax)
  		ADDITIONAL MEMBER
  		0-17	18-44	45-54	55-60	61-65
  5,00,000	5,00,000	700	900	1,450	2,010	3,350
  	10,00,000	1,100	1,400	2,250	3,150	5,250
  	15,00,000	1,400	1,750	2,800	4,020	6,700
  8,00,000	7,00,000	600	800	1,250	1,920	3,200
  	12,00,000	900	1,150	1,850	2,880	4,800
  	17,00,000	1,200	1,500	2,350	3,720	6,200
  	22,00,000	1,400	1,800	2,800	4,470	7,450

Family Floater Mediclaim Policy

• Who can take this Policy?

• What does this Policy Cover?

• Exclusions

• Premium

• Special Features of the Policy

• How to Avail Claim?

Who can take this Policy?

1. FLOATER BENEFIT means the Sum Insured as specified for the proposer under the policy, is available for any or all the members of his /her family for one or more claims during the tenure of the policy.

1. The Family Floater Mediclaim Policy can be issued to the persons up to 60 years of age covering the following family members:

• Self

• Spouse

• Dependent children ? Maximum two

1. Parents/Parents-in law/ brothers and sisters are not covered under Family Floater Mediclaim Policy even if they are residing with the proposer.

1. Sum Insured: Minimum Sum Insured is Rs. 2 lacs and Maximum Sum Insured is Rs 5 lacs.

1. Premium: Premium is as per Individual Mediclaim Policy (2007). The basic premium will be as per highest age of the family member. Apply 50% loading for covering spouse, and 25% loading for covering each and every additional dependent child.

TopTop What does this Policy Cover?TopTop Exclusions

• Diseases contracted within 30 days of insurance.

• Dental treatment except arising out of accident.

• Debility and General Run Down Conditions.

• Sexually transmitted diseases and HIV (AIDS).

• Circumcision, Cosmetic surgery, Plastic surgery unless required to treat injury or illness.

• Vaccination and Inoculation.

• Pregnancy and child birth.

• War, Act of foreign enemy, ionizing radiation and nuclear weapon.

• Treatment outside India.

• Naturopathy.

• Domiciliary Treatment.

• Experimental or unproven treatment.

• All external equipments such as contact lenses, cochlear implants etc.

TopTop PremiumTopTop Special Features of the Policy

• Loyalty Discount.

• Good Health Discount.

• Income Tax Benefit under Section 80D of IT Act.

TopTop How to Avail Claim?TopTop        Personal Accident PolicyScope
Table D

1. Death cover wherein 100% of the capital sum insured is payable.

Table C

1. Coverage under Table D

1. Loss of two limbs / both eyes / one limb and one eye wherein 100% of the capital sum insured is payable.

1. Loss of one limb or one eye wherein 50% of the capital sum insured is payable.

1. Permanent Total Disablement other than above e.g. paralysis due to an accident, wherein 100% of the capital sum insured is payable.

Table B

1. Coverage under Table C

1. Permanent Partial Disablement i.e. where a part of the body becomes permanently disabled due to an accident, e.g. total and irrevocable loss of use of a finger due to an accident. In such cases, a percentage of the capital sum insured as specified in the policy is paid.

Table A

1. Coverage under Table B

1. Temporary Total Disablement i.e. where the insured person becomes temporarily disabled from undertaking any work as a result of an accident for e.g. fracture of legs. In such cases, a weekly payment of 1% of the capital sum insured subject to a maximum limit, is paid for the number of weeks or part thereof (maximum 100 weeks), during which the insured person is totally disabled.

• Individual Personal Accident policy.

• Group Personal Accident policy.

• Passenger Flight Coupon - Covering personal accident risk whilst traveling as a passenger on a scheduled flight.

• Gramin Personal Accident Policy - for persons residing in rural areas where benefits as per Table C mentioned above are covered for a capital sum insured of Rs. 10,000/-.

• Janata Personal Accident policy - where benefits as per Table C mentioned above are covered for a maximum sum insured of Rs.1,00,000/-. Long Term Policies can also be issued upto 5yrs.

• Student Safety Insurance - for schools and colleges, covering students against Personal Accident benefits as per Table B mentioned above for a capital sum insured of Rs. 10,000/-.

• Raj Rajeshwari Mahila Kalyan Yojna - for women in the age group of 10 to 75 years. where benefits as per Table C mentioned above are covered for a capital sum insured for Rs. 25,000/-. In case of death of an unmarried woman due to an accident, Rs. 25,000/- is payable to the nominee or legal heir. In case of a married woman, if the husband dies due to an accident, Rs. 25,000/- is payable to the wife but if the wife or insured dies no compensation is payable.

• Bhagyashree Child Welfare Policy - for girl child in the age group of 0 to 18 years. whose parents age does not exceed 60yrs. In case of death of either or both parents due to an accident, a sum of Rs. 25,000/- is deposited in the name of the girl child with a financial institution named in the policy which will disburse amounts as specified for the benefit of the girl child to the living parent or to the nominated guardian. Group policies can also be issued.

TopTop Add on coversTopTop

• Highlights

• Scope

• Add on covers

• Who can take the policy?

• How to select the sum insured?

• How to claim?

HighlightsTopTop Who can take the policy?TopTop How to select the sum insured?TopTop How to claim?
In case of death claim:-

1. Assignee under the policy should immediately notify the policy issuing office.

1. Submit the claim form alongwith death certificate, post mortem report, police report and original policy.

In case of injury claim:-

1. Notify the policy issuing office immediately.

1. Submit Police report if any.

1. Submit claim form alongwith medical certificate certifying the disablement.

1. In case medical expenses extension has been taken, then the prescription alongwith bills are to be submitted.

TopTop Money Insurance

• Highlights

• Scope of Cover

• Basis of Sum Insured

• Extensions

• Exclusions

HighlightsTopTop Scope of CoverTopTop Basis of Sum Insured

• Limits of liability for any one loss (i.e. maximum liability of the Company)

• Estimated amount in transit during the year for the purpose of premium computation.

TopTop ExtensionsTopTop Exclusions

1. Shortage due to error or omission

1. Losses due to the fraud/dishonesty of the employee of the insured.

1. Losses which are covered by other policies

TopTop Mobile / Cellular Phone Insurance

• Highlights

• Scope

• Exclusions

• Compensation

Highlights TopTop Scope

1. Fire.

1. Riot, strike, malicious damage and terrorist activities.

1. Theft.

1. Accident.

1. Fortuitous circumstances.

TopTop Exclusions

• Mysterious disappearance.

• Theft from unattended vehicles, except from fully enclosed car that is securely locked.

• Theft, loss or damage during the hire or loan to a third party.

• Mechanical and electronic breakdown or derangement.

• Overloading and experimentation involving imposition of any abnormal conditions.

• Damage by wear and tear, vermin, atmospheric or climatic condition or gradual deterioration, inherent defect or from any process of cleaning, repairing or maintenance.

• Loss or damage due to war or nuclear perils, loss by water or from any water borne craft.

• Intentional or willful act of the insured party.

TopTop Compensation
Other Personal Insurance

• Baggage Insurance

• Birthright Insurance

• All Risk Insurance

• Gun Insurance

• Highlights

• Scope

• Exclusions

• Special Conditions

HighlightsTopTop ScopeTopTop Exclusions

1. Loss or damage arising from war, civil commotion, depreciation, wear & tear

1. Damage to watches and clocks over winding

1. Damage caused by mechanical derangement or electrical breakdown

1. Breakage of glass articles, china clay

1. Theft from unattended vehicles

1. Detention or confiscation by customs or other authorities

1. Money, securities, manuscripts, deeds, bonds, bills of exchange, promissory notes, share certificates, stamps

1. Articles while being worn or in actual use at the time of such loss or damage

TopTop Special Conditions

• Each item of jewellery, gold ornaments, etc. is to be specifically Declared for insurance and a valuation certification should be obtained in respect of such items valued at more than Rs.5, 000/-

• Where the total value of jewellery, ornaments etc. is in excess of 50% of the total value at risk, an additional premium to be charged on the value of such items.

• The policy may be extended to cover riot & strike risks by charging an additional premium.

TopTop Birthright Insurance

• Applicability

• Age Group

• Identification

• Scope of Cover

• Exclusion

ApplicabilityTopTop Age GroupTopTop IdentificationTopTop Scope of Cover

1. CONGENITAL ANOMALIES, and if such Congenital Anomalies result into (a) Temporary Disablement or (b) Permanent Total Disablement or (c) Permanent Partial Disablement, at the time of birth or within 2 years thereof in respect of those anomalies which generally manifest later, and shall require any such insured upon the advice of a duly qualified Physician/ Medical Specialist/ Medical Practioner/ Pediatrician/Obstetrician/ Gynecologist.

1. In respect of Congenital Anomalies certified by a Medical Practitioner, Permanent Total Disablement, the Company will also deposit the balance unspent amount (unutilized limit) with a Bank or Unit Trust of India and monthly benefit by way of interest will be available to the insured for the maintenance of the child. On death of Insured, the said monthly interest will be available to the natural guardian or failing that to the legally appointed guardian under whose care the child was placed. On death of the child, the corpus amount will be available to the natural guardian or legally appointed guardian as the case may be.

1. In respect of congenital Anomalies certified by a Medical Practitioner as Permanent Partial Disablement, the Company will also deposit such percentage of the balance amount (unutilized limit) as certified by a Medical Practitioner to be the percentage of permanent partial disability, in Bank or Unit Trust of India and monthly benefit by way of interest will be available to the insured for the maintenances of the child. On death of Insured, the said monthly interest will be available to the natural guardian or failing that to the legally appointed guardian under whose care the child was placed. On death of the child, the corpus amount will be available to the natural guardian or legally appointed guardian as the case may be.

TopTop Exclusion

1. Congenital Anomalies directly or indirectly caused by or arising from or attributable to War, Invasion, Act of Foreign Enemy, Hostilities or warlike operations (whether war be declared or not) and breach of Criminal Law by the Insured.

1. Congenital anomalies directly or indirectly caused by or arising from ionizing radiations or contamination by radioactivity from any source whatsoever.

1. Expenses on vitamins and tonics unless forming part of treatment for congenital anomalies as certified by the attending Physician.

1. If the Insured is a heavy consumer of alcohol/narcotics/smoking.

1. If the Insured has been exposed to excessive radiation, X-rays, drugs for treatment of disease like cancer etc.

1. Conceivement by the Insured against medical advice.

1. Congenital Anomalies occurring due to the existence of proven inherited disorders/abnormalities in the family or in any of the earlier children to which the Insured has given birth unless the required pre-natal tests have been carried out and the reports thereof are positive.

TopTop All Risk Insurance

• Highlights

• Scope

• Exclusion

• Claim Procedure

HighlightsTopTop Scope

1. Fire

1. Riot and Strike

1. Theft

1. Accident

1. From any fortuitous cause

TopTop Exclusion

1. Damage caused by any process of cleaning, dyeing or bleaching, restoring, repairing or renovation or deterioration arising from wear and tear, moth, vermin, insects or mildew or any other gradually operating clause.

1. Breakage, Cracking or Scratching of Crockery, Glass, Cameras, Binoculars, Lenses, Sculptures, Curios, Pictures, Musical Instruments, Sports Gear, and similar articles of brittle or fragile nature, unless caused by fire or accident to the means of conveyance.

1. Loss or damage caused by mechanical or electrical derangement/breakdown of any article unless caused by accidental external means.

1. Over-winding, denting or internal damage of watches and clocks.

1. Loss or damage to Money, Securities, Manuscripts, Deeds, Bonds, Bills of Exchange, Promissory Notes, Stocks or Share Certificates, Stamps and Travel Tickers or Travellers Cheques, Business books or documents.

1. Theft from any car except car of fully enclosed saloon type having at the time all the doors, windows and other openings securely locked and properly fastened.

1. Loss or damage whether direct or indirect arising from War, War-like operations, Act of Foreign Enemy, Hostilities (whether war be declared or not) Civil War, Rebellion, Insurrection, Civil Commotion, Military or Usurped Power, Seizure, Capture, Confiscation, Arrests, Restraint and Detainment by the order of any Government or any other authority.

1. Any loss or damage arising through delay, detention or confiscation by Customs or other authorities.

1. Any loss, destruction or damage to any property whatsoever or any loss or expense whatsoever, resulting or arising therefrom or any consequential loss and any legal liability of whatsoever nature, directly or indirectly caused by or contributed to by or arising from Ionising, radiation or contamination by radioactivity from any source whatsoever.

1. Any loss, destruction, damage or Legal Liability directly or indirectly caused by or contributed to by or arising from Nuclear Weapons material.

1. Consequential losses or legal liability of any kind.

1. Loss or damage due to or contributed to by the Insured having caused or suffered anything to be done whereby the risks hereby insured against were unnecessarily increased.

1. Loss or damage due to or contributed to by Terrorism and Sabotage activities.

TopTop Claim Procedure

1. The Insured shall give immediate notice thereof in writing to the nearest office with a copy to the Policy Issuing Office of the Company as well as lodge forthwith a complaint with the Police. The Insured must also notify the Railways, Steamship Company, Airline, Hotel Proprietors, or the Authority in whose care the property vest at the time of the happening of any loss or damage.

1. The Insured shall deliver to the Company, within 14 days of the date on which the event shall have come to his knowledge, a detailed statement in writing, of the loss or damage, with an estimate of the intrinsic value of the property lost and the amount of damage sustained.

TopTop Gun Insurance

Scope

• Exclusion

Scope
Section I: Loss or Damage

1. Fire

1. Burglary

1. House-breaking

1. Larceny

1. Theft

1. Any other accident or misfortune not excluded

Section II: Third Party Liability

1. Death of or bodily injury to any person other than a member of the Insured's family or household or in his service under a contract of service or apprenticeship.

1. Damage to property not belonging to or in the charge or under the control of the insured or of a member of his family or household or of a person in his service.

TopTop Exclusion

1. The Company shall not be liable to pay any claims under the above section II in respect of any death, injury or damage caused intentionally, or as a result of carelessness or negligence.

1. Loss, damage, injury, death or liability directly or indirectly occasioned by war, invasion, act of foreign enemy, hostilities (whether war be declared or not) civil war, rebellion, revolution, insurrection, military or usurped power or riot or civil, commotion.

1. Loss or damage to guns occasioned by any process of cleaning or by wear and tear.

1. Any accident or any loss or destruction of or damage to any property whatsoever or any loss or expense whatsoever resulting or arising therefrom or any consequential loss.

1. Payment of compensation in respect of death, injury, disablement of the insured person directly or indirectly caused by or contributed to by or arising from ionizing radiation or contamination by radioactivity from any source whatsoever.

TopTop

• 
  
  The policy can be issued on Individual or Floater Sum Insured basis covering up to 6 members of the family. If the policy is to be issued on Individual Sum Insured basis, then separate document will be issued to each Insured. Family comprises of Self, Legal Spouse, dependent Children and dependent Parents.
  Age of Entry:
  Proposer : 18 to 65 years.
  Other members : 3 month to 65 years.
  There is no cover ceasing age in case of renewal.
  Children between the age of 3 months and 18 years are covered provided either or both parents are covered concurrently. Children between the age of 18 years and 25 years are covered only if either or both the parents are also covered and they are financially dependent on the parents. But this upper limit is not applicable for Unmarried Daughter and Mentally Challenged Children. Exclusion for treatment related to Psychiatric and Psychosomatic disorder will apply for such Mentally Challenged Children regardless of Continuous Coverage.

• Pre–acceptance health check–ups will be required in the following instances:
  Note: No Pre–acceptance Health Check–up for persons above 50 years of age, if the person has Health insurance policy from our company and there is no claim for previous two years.
  A person is said to have Adverse Medical History if he/she:
  Following are the test to be carried out as pre–acceptance health check–up:

• The above tests will have to be carried out at proposer’s cost. However if the proposal is accepted then 50% of such cost will be reimbursed to the proposer.
  The tests have to be taken not more than 30 days prior to the date of submission of the proposal.
  This policy will be valid for a period of one year from the date of inception.
  The Sum Insured available are:

• "Proposers are advised to exercise care in choosing the amount of Threshold, as such choice will have an impact on benefits available under the Policy such as Room Rent limit, Hospital Cash, Ambulance Charges, and Get Well Benefit."
  The following Hospitalisation expenses incurred in respect of all the Insured members shall be considered for determining the Threshold under the Policy:
  As per table attached.

• Note: The Proposer may not be the primary member.
  Hospitalisation Expenses,
  Expenses on Hospitalisation for minimum period of 24 hours are admissible. However, this time limit is not applied for some specific treatments like Dialysis, Chemotherapy, Radiotherapy, Eye surgery, Dental Surgery, Lithotripsy (Kidney Stone removal), D & C, Tonsillectomy or where treatment involves technological advances necessitating hospitalisation for less than 24 hours.
  No payment shall be made for any Hospitalisation expenses incurred, unless they form part of the Hospital Bill. However, the bills raised by Surgeon, Anaesthetist directly and not included in the Hospital Bill shall be paid, provided a numbered Bill is produced in support thereof, for an amount not exceeding Rs. Ten thousand, where such payment is made in cash and for an amount not exceeding Rs. Twenty thousand, where such payment is made by cheque
  Note: Procedures/treatments usually done in outpatient department are not payable under the policy even if converted as an in–patient in the hospital for more than 24 hours or carried out in Day Care Centres.
  All claims will be processed and settled by specified Third Party Administrator (TPA) licensed by IRDAI.
  Intimation of Hospitalisation to be given to the TPA 48 hours before Hospitalisation, for planned Hospitalisation. For emergency Hospitalisation, intimation is to be given within 48 hours from the time of Hospitalisation.
  To avail Cashless facility - Pre-authorisation request to be sent or faxed to TPA immediately on admission.
  In Reimbursement cases - Insured to intimate TPA about Hospitalisation of Insured Persons immediately on admission. Claim bills to be submitted to TPA within seven days of discharge.
  In case of Hospitalisation where the expenses are likely to involve the TPAs of both regular Health Policy and New India Top Up Mediclaim Policy, the intimation/pre-authorisation request with regard to a Hospitalisation is to be given to both the TPAs of these Policies.
  In the case of a covered Hospitalisation, the costs of which were not initially estimated to exceed the Threshold but were subsequently found likely to exceed the Threshold, the intimation to the named TPA should be submitted along with a copy of intimation made to the Primary Health Policy TPA/Reimbursement Provider immediately on knowing that the Threshold is likely to be exceeded.
  The payment will be made either to Hospital in case of Cashless treatment or to the Proposer/Insured Person in other cases.
  The TPA of the regular Health Insurance Policy/Reimbursement Provider will first process the claims and the TPA for this policy will make the balance admissible payments either to the Hospital in the case of cashless settlement or to Insured in case of reimbursement. The Insured has to submit the details of settlement made by the TPA of regular Health Insurance Policy in the case of cashless settlement. In the case of reimbursement, the above details along with photo-copies of bills attested by Primary TPA/Reimbursement Provider are to be submitted to TPA of New India Top Up Mediclaim Policy.
  The details of claims lodged and settlement details under regular Health Policy since inception of this policy should be furnished to the TPA of New India Top Up Mediclaim Policy even when the claim is not under the New India Top Up Mediclaim Policy. These documents are to be submitted to the TPA not later than thirty days from the date of discharge from the Hospital.This will enable faster response by the TPA in case of future Hospitalisation requiring the services of this policy.
  All claims under this policy shall be payable in Indian currency.
  Any Claim which goes beyond the Threshold and Insured makes a claim in this policy, will be adjudicated as examples given below:

• Insured is not eligible to receive any amount more than the admissible claim. If he goes to a higher Room Rent category than his eligible Room Rent category, the claimed amount will be proportionately deducted and the deducted amount will not be payable even in Top Up. But if he goes to his eligible Room Rent category, the claim will be settled in full without any deductions in the admissible amount.
  The Company may at any time cancel this Policy on grounds of misrepresentation, fraud, non-disclosure of material fact or non-cooperation by Insured by sending 15 days’ notice by registered letter at the Insured’s last known address and in such event the Company shall not refund any premium.
  The Insured may at any time cancel this Policy and in such event the Company shall allow refund of premium at Company’s short period rate only (table given below)provided no claim has occurred up to the date of cancellation however the company shall remain liable for any claim/ claims arising prior to such cancellation.

• Tax rebate, as per provision of Income Tax rules, under Section 80-D.
  The Policy may be renewed by mutual consent and in such event the renewal premium shall be paid to the Company on or before the date of expiry of the Policy or of the subsequent renewal thereof and in any case not later than 30 days from the date of expiry of the current policy.
  If, during the grace period of 30 days, any Insured Person incurs any Hospitalisation expenses, he shall not be entitled for any claim.
  The Company shall not be bound to give notice that such renewal premium is due, provided however that if the Insured shall apply for renewal and remit the requisite premium before the expiry of this policy, renewal shall not be refused, unless the Company has reasonable justification to do so.
  A policy that is sought to be renewed after the grace period of 30 days will be underwritten as a Fresh Policy.
  Request for increase in Sum Insured at renewals may be considered, after a satisfactory pre-acceptance health check-up.
  This Prospectus shall form part of the proposal form. Please sign in token of having noted the contents of Prospectus.
  Signature                                                                                                                                                Place:
  Name                                                                                                                                                      Date:

• Once the Insured Person crosses the age of 65 years, the applicable premium on renewal will be loaded by 2.5% per year. This loading is applicable on premium for the age band of 61 - 65years.
  E.g.: Premium for a person aged 69 for SI of 22,00,000 will be 7450 (base premium of 61-65) + (7450 * (2.5%*4)) = 8195   
  
  
  

  We have designed a new Policy called as Family Floater Mediclaim Policy for covering the family members with one sum insured. All the terms and conditions of Individual Mediclaim Policy 2007 will be applicable for Family Floater Mediclaim Policy.

  
  
  

  This insurance is available to persons between the age of 18 years to 60 years. The persons beyond 60 years can continue their insurance provided they are insured under Mediclaim policy with our Company without any break.

  
  
  

  The policy covers hospitalization expenses for the treatment of illness/injury provided hospitalization is more than 24 hours. Pre-hospitalization expenses for 30 days and post hospitalization expenses for 60 days are also payable.

  Day-care treatment - The Medical expense towards specific technologically advanced day-care treatments / surgeries where 24 hour hospitalization is not required.

  Ambulance Charges for shifting the insured from residence to hospital are covered up to the limits specified in the policy.

  Ayurvedic/Homeopathic and Unani system of medicine are covered to the extent of 25% of Sum Insured provided the treatment is taken in the Registered Hospital.

  Pre-existing diseases are covered only after 4 continuous and claim free renewals with our Company.

  Pre-existing conditions like Hypertension, Diabetes, and their complications are covered after two years of continuous insurance on payment of additional premium.

  
  
  
  

  Premium is based on age of the proposer and geographical area of treatment. The following 3 zones have been made for rating: ZONE-I (MUMBAI), ZONE-II (DELHI & BANGALORE) AND ZONE-III (REST OF INDIA). Premium will be charged depending on the Zone in which the insured undertakes to seek hospitalization.

  
  
  
  

  Claims are administered through Third Party Administrators (TPA) whose contact particulars appear on the policy document. Insured can opt for cashless or reimbursement facility for their claims.

  For more details please contact our nearest Office.

  
  

  Note: Policy details given are indicative, not exhaustive. Please contact your nearest NIA office for further details.

      

  This policy is basically designed to offer some sort of compensation to the insured person who suffers bodily injury solely as a result of an accident which is external, violent and visible. Hence death or injury due to any illness or disease is not covered by the policy.

  The following types of coverages are offered under a Personal Accident policy:-

  The insured can claim only under any one of these sections as a result of any one accident.

  The policy also covers expenses incurred for carriage of dead body from place of accident to the residence subject to a limit of 2% of the capital sum insured or Rs.2,500 whichever is less. Under an Individual Personal Accident policy or Family Package Policy, an education fund is payable for a maximum of 2 dependent school going children, in case of death or permanent total disablement of the insured person.

  We issue several types of personal accident policies such as:-

  
  
  

  Individual and group personal accident policies can be extended to cover medical expenses incurred in the treatment of an accident covered under the policy, subject to a limit of 10% of the sum insured or 40% of the death / disability compensation claim payable, on payment of additional premium.

  The policy issued to Indian personnel working in foreign countries on civilian duty can be extended to cover War risk on payment of additional premium.

  The policy can also be restricted to cover Personal Accident risk during duty hours only or during off-duty hours only with discount in premium. It is also possible to issue group P.A. policy excluding the death benefit subject to a group life policy covering death benefit being taken for the same group of persons for the same policy period.

  The insurance provides compensation in the event of death or disability directly due to accident.

  
  
  

  This policy offers compensation in case of death or bodily injury to the insured person, directly and solely as a result of an accident, by external, visible and violent means.

  The policy operates worldwide and is a 24 hours cover.

  Different coverages are available ranging from a restricted cover of Death only, to a comprehensive cover covering death, permanent disablements and temporary total disablements.

  Family Package cover is available to Individuals under Personal Accident Policy whereby the proposer, spouse and dependent children can be covered under a single policy with a 10% discount in premium.

  Group personal accident policies are also available for specified groups with a discount in premium depending upon the size of the group.

  
  
  

  Any adult residing in India can take the policy covering himself / herself and dependent family members between the ages of 5 and 70yrs.

  
  
  

  It is very difficult to put a value to a human life. Hence the principle of indemnity cannot be applied in this policy. However it becomes necessary to apply some yardstick for fixing the sum insured so that human lives are not overvalued for ulterior motives.

  Hence the capital sum insured is restricted to 72months income from gainful employment. This means that income from property, shares etc. will not be taken into account. For non working spouse, the sum insured is restricted to 50% of the sum insured of earning spouse subject to a maximum of Rs. 1,00,000/- and for dependent children to 25% of the sum insured of earning parents subject to a maximum of Rs. 50,000/-. In case of Gramin Personal Accident, Student Safety, Raj Rajeshwari, Bhagyashree policies the sum insured is fixed.

  In Individual Personal Accident policy, facility of cumulative bonus is given whereby the capital sum insured is increased by 5% every year on claim free renewals subject to a maximum of 50%. This cumulative bonus is available only under tables A, B & C.

  
  
  

  In the event of an accident giving rise to a claim the following steps should be taken:-

  Note: Policy details given are indicative, not exhaustive. Please contact your nearest NIA office for further details.                                                  

  
  
  

  Money Insurance policy provides cover for loss of money in transit between the insured's premises and bank or post office,or other specified places occasioned by robbery, theft or any other fortuitous cause.

  The policy also cover loss by burglary or housebreaking whilst money is retained at Insured's premises in safe(s) or strong room.

  
  
  

  Section I: Covers money in transit under the following heads: Cash, Bank Drafts, Currency Notes, Treasury Notes, Cheques, Postal Orders and current Postage Stamps.

  Section II: Covers money in safe / on premises

  
  
  

  Two amounts are specified in the policy:

  
  
  

  This policy can be extended to include the risk of infidelity of the employees, terrorism and disbursement risk.

  
  
  

  Note: Policy details given are indicative, not exhaustive. Please contact your nearest NIA office for further details.                             

  
  
  

  Suitable for cell phone owner/users who can insure their mobile telephone instrument from loss and/or damages under this policy

  
  
  

  The policy for mobile phones provides cover against

  
  
  

  Exclusions under the mobile phone insurance policy are

  
  
  

  The insurance cover provides compensation equivalent to the the cost of replacement of the instrument by a new instrument of the same specification and same capacity, including all taxes and duties.

  • 
    
    

    Policy provides cover against loss of or damage to accompanied personal baggage of the insured or insured's family
    Loss or damage due to fire, theft or accident during the course of journey including stoppages en-route, anywhere in India
    Note: Policy details given are indicative, not exhaustive. Please contact your nearest NIA office for further details.                                         
    
    
    
    

    Expectant mother upto 3 months pregnancy
    18 years to 40 years
    Birth certificate of the child issued by the hospital.
    Note: Policy details given are indicative, not exhaustive. Please contact your nearest NIA office for further details.      
    
    
    
    

    The company will pay compensation to the Insured to the extent of the intrinsic value of the property (Gold, silver ornaments, jewellery, watches, cameras and other valuables) of the Insured or member(s) of his family, so lost, destroyed or damaged.
    Covers Loss or damage caused by
    The Company shall not be liable in respect of:-
    Upon the happening of any event giving rise or likely to give rise to a claim under this Policy:
    The Insured shall tender to the Company all reasonable information, assistance and proofs in connection with any claim hereunder and shall, if required, make an Affidavit or statutory declaration in substantiation of such claim.
    Note: Policy details given are indicative, not exhaustive. Please contact your nearest NIA office for further details.

    If any of the guns described and included in the Schedule and belonging to the Insured shall be lost damaged or destroyed by

    Whilst such property is anywhere in India

    If any claim or claims shall be made on the Insured in respect of accident caused by him whilst using a sporting gun anywhere in India resulting in:

    And the Insured shall be legally liable for the same then the Company will pay the amount of such claim or claims upto but not exceeding Rs. 50000/- or Rs. 100000/- as specified in the schedule in respect of any one claim or series of claims constituting one occurrence, in addition to the claimants costs and expenses incurred with its written consent.

    Note: Policy details given are indicative, not exhaustive. Please contact your nearest NIA office for further details.